Provider Demographics
NPI:1083064109
Name:MAZARD, MICHELA LAMBERT (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELA
Middle Name:LAMBERT
Last Name:MAZARD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:MICHELA
Other - Middle Name:
Other - Last Name:LAMBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:NMRTU ATSUGI NAF ATSUGI, BLDG 21
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96306
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:NMRTU ATSUGI NAF ATSUGI, BLDG 21
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96306
Practice Address - Country:JP
Practice Address - Phone:315-264-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2023-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5286363LF0000X
FLARNP9327567363LF0000X
FLAPRN9327567363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL363L00000XMedicaid